Investigations Incident Causation Not Just for Fatalities Objectives • Familiarize with incident causation • Apply root cause analysis Heinrich Domino Theory Management / Root Cause • Management Structure objectives organization operations Operational Error Manager behavior/Supervisor behavior Tactical Error unsafe acts unsafe conditions LCU Theory • Accident probability is situational • Overload taxes person’s capacity • Leads to accidents (or illness) • >300 → 79% in 2 yrs • >200 → 51%
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1. PROJECT. To Design an Accident Causation Model 2. SCOPE. The Accident Causation Model (or "Swiss Cheese Model") is a theoretical model that illustrates how accidents occur in organisations. The model focuses on both organisational hierarchy and human error. It postulates that the typical accident occurs because several (human) errors have occurred at all levels in the organisational hierarchy in a way that made such accident unavoidable. For example‚ decision makers may have made ill decisions
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Bergquist‚ M. F. (2005). TQM: terrific quality marvel or tragic quality malpractice? ‚ 311. Bjarne Bergquist‚ M. F. (2005). TQM and results as profit in commercial organizations. TQM: terrific quality marvel or tragic quality malpractice? ‚ 312. Campbell‚ J. (1995). Uptime: Strategies for Excellence in Maintenance Management (Step-by-step Approach to TPM Implementation). Productivity Press Inc. ‚ 733. Crosby‚ P. (2001). Let ’s Talk Quality: 96 Questions that You Always Wanted to Ask Phil Crosby. International
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duty operational staff and workers from various departments and maintenance services. In addition to this number‚ there were also 268 builders and assemblers working on the night shift of the constructions of units Nos.5 and 6. The fatal accident sequence was initiated by a decision of the plant ’s management and specialists to make an overnight experiment to test the ability of the turbine generator to power certain of the cooling pumps while the generator was freewheeling to a standstill
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1. Distracted Driving The number one cause of car accidents is not a criminal that drove drunk‚ sped or ran a red light. Distracted drivers are the top cause of car accidents in the U.S. today. A distracted driver is a motorist that diverts his or her attention from the road‚ usually to talk on a cell phone‚ send a text message or eat food. 2. Speeding You’ve seen them on the highway. Many drivers ignore the speed limit and drive 10‚ 20 and sometimes 30 mph over the limit. Speed kills‚ and traveling
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CAUSATION Causation refers to inquiry as to whether the defendants conduct (or omission) caused the harm or damage. Causation must be established in all result crimes. In criminal liability it is divided into Factual causation and Legal causation. Factual causation is the starting point and consist of applying the ‘but for’ test. In most instances where there exists no complicating factors‚ factual causation on its own will suffice to establish causation. However‚ in some circumstances it will also
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PRINCIPLE OF CAUSATION Every criminal action can be divided into actus reus‚ mens rea and causation. Actus reus compacts with the ‘guilty act’‚ mens rea with the ‘guilty mind’ and the causation compacts with the consequences of the actus. In crimes‚ which require consequence like murder‚ causation is a essential and imperative element. The absence of causation between the actus and the consequence may render a verdict untenable in spite of the existence of the necessary mens rea and actus reus
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ABSTRACT Nowadays‚ many companies use modern technology in the operation of their business. However‚ there are some companies that still use the traditional way in processing their data and one of this is Hi-Safety Industrial Supplies‚ Inc. The study will propose a monitoring and inventory system for Hi-Safety Industrial Supplies‚ Inc. The business uses manual way of monitoring of daily transactions and conducting an inventory. All the necessary records of completed transaction are
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The brain is a very complex system. As our body changes through the years‚ so does our brain. When we are infants‚ our brains are reworking. As we learn‚ make memories‚ use our reflexes‚ and develop basic survival skills. The brain is growing incredibly rapidly during these early years. Are neurons are getting bigger‚ and are working more efficiently. Causing us to gain connection between hearing to vision. Near the end of the early stages‚ you would be two years old‚ and your brain will be about
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Models of Causation: Safety OHS Body of Knowledge Models of Causation: Safety April‚ 2012 Copyright notice and licence terms First published in 2012 by the Safety Institute of Australia Ltd‚ Tullamarine‚ Victoria‚ Australia. Bibliography. ISBN 978-0-9808743-1-0 This work is copyright and has been published by the Safety Institute of Australia Ltd (SIA) under the auspices of HaSPA (Health and Safety Professionals Alliance). Except as may be expressly provided by law and subject
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